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Will your risk analysis stand up to scrutiny? Map out a plan

02/02/2026

The Office for Civil Rights (OCR) is clearly watching how organizations evaluate risk assessments, conduct vendor oversight and execute breach preparedness. The findings detailed in OCR’s recent settlement with Comstar LLC were not obscure legal nuances. Instead, they revealed a basic failure to conduct a thorough organization-wide risk analysis, a core expectation under the HIPAA Security Rule.

Use a checklist to prevent real-life virtual direct supervision mistakes

02/02/2026

by: Julia Kyles, CPC

Medicare’s new rule that allows virtual direct supervision gives your providers more flexibility and creates the potential to bill more services under incident-to rules.

Prolonged services E/M code gains favor as practices gain millions

02/02/2026

by: Richard Scott

In the four years since prolonged services code G2212 made its debut in 2021, practices have ramped up their use of the 15-minute add-on code, with claims surging 88% between 2021 and 2024.

Watch for E/M scrutiny with diagnostic X-rays, as denials rise

01/26/2026

by: Laura Evans, CPC

Some coders at this year’s Advanced Specialty Coding Virtual Summit reported increased denials for E/M visits billed at the same encounter as an X-ray. Practices should be watchful for these and challenge them when they occur, billing experts advise.

New CMMI model to award proposals on chronic conditions, ‘lifestyle’ interventions

01/26/2026

by: Roy Edroso

Up to 30 proposals will be accepted under a new $100 million Center for Medicare and Medicaid Innovation (CMMI) model. While details about the MAHA ELEVATE (Make America Healthy Again: Enhancing Lifestyle and Evaluating Value-based Approaches Through Evidence) model are scarce, early signs suggest that behavioral health providers, and those currently coordinating complex care, will have an advantage.

After Cigna’s downcoding policy, monitor claims and other payers

01/26/2026

by: Dom Nicastro

Cigna’s new E/M Coding Accuracy (R49) policy, which took effect October 1, will automatically review — and in some cases, downcode — level 4 and 5 E/M claims that the insurer believes are inconsistent with typical coding patterns.

You can use MDM or time when critical care becomes a hospital E/M

01/26/2026

by: Julia Kyles, CPC

Question: The provider performs a service that they believe meets the requirements for critical care services. They document the service and the total time. However, the documentation does not support the severity or complexity required for a critical care service. Can the practice use the time to report a level-based hospital E/M code, or does it have to use medical decision-making (MDM)?

Physician e-visit codes up, but version for QHPs shows struggles

01/26/2026

by: Roy Edroso

Utilization of the e-visit codes established before the pandemic in 2020, represented by 99421-99423 (Online E/M for physicians) and 98970-98972 (Online assessment and management [A/M] for non-physician qualified health professionals), suffered in the aftermath of the public health emergency.

Test your coding skills with the case of the PACU boarder

01/19/2026

by: Julia Kyles, CPC

Your billing practitioners work hard, especially when they perform critical care services. Training your clinical and coding staff with real-world examples can make sure your providers get full credit for their work.

The case of the PACU boarder: Discover the answer

01/19/2026

by: Julia Kyles, CPC

Your physicians and qualified health care professionals won’t get full payment for critical care services if their documentation falls short or coders miss key elements. During the 2025 Advanced Specialty Coding Virtual Summit: Anesthesia, Marcy Garuccio, ACS-AN, CANPC, CPMA, CPC, SME, AAPC Fellow and Laura McNeill, M.D., ABA, ASE, shared a critical care scenario. Read the case, decide which service or services McNeill can report and then check your answer below.

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